Esophageal Necrosis

Acute esophageal necrosis (AEN), also referred to as black esophagus, Gurvits syndrome, or acute necrotizing esophagitis, is a rare and life-threatening condition affecting the esophagus. This condition is characterized by either partial or total circumferential blackening of the esophagus that stops abruptly at the gastroesophageal junction, as observed on an upper gastrointestinal endoscopy. AEN was first documented in 1990 by Goldberg et al, and the exact cause remains unclear, but AEN tends to follow a pattern of acute ischemia associated with a topical insult to the esophagus. AEN has a prevalence of up to 0.2% in the autopsy series and ranges from 0.01% to 0.28% in the endoscopy series. This condition occurs more frequently in males, with an incidence up to 4 times higher compared to that in females, and typically affects middle-aged individuals. AEN predominantly impacts the distal esophagus, affecting 97% of cases. AEN typically spares the proximal two-thirds of the esophagus and almost always stops at the gastroesophageal junction. Management of AEN is primarily medical but can include surgical intervention in the event of complications such as perforation and mediastinitis. Overall mortality associated with AEN is approximately 30%; however, mortality specific to AEN is closer to 5%.